Effects of pulsed-radiofrequency neuromodulation on the rat with overactive bladder

Jen, En; Hsieh, Tsung‐Hsun; Lu, Tsung Che; Chen, Meng Chao; Lee, Fu Jung; Lin, Chih Ting; Chen, Shih Ching; Chu, Pei Yi; Peng, Chih‐Wei; Lin, Chii-Wann

doi:10.1002/nau.23183

Cited by 8 publications

(4 citation statements)

References 30 publications

(45 reference statements)

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“…In the clinical setting, sacral nerve stimulation is the procedure offered most commonly in cases that are refractory to current pharmacological and chemodenervation approaches, although other targets are also being used (see Janssen et al, 2017 for a recent review). In animal studies the net has been cast wider and there are several indications from studies in anesthetized cats and rats that stimulation of the tibial, saphenous, pudendal, dorsal penile, dorsal clitoral, and pelvic nerves all have the potential to modulate voiding ( Snellings and Grill, 2012 ; Su et al, 2012a , b ; Kovacevic and Yoo, 2014 ; Jen et al, 2016 ; Langdale et al, 2017 ; Moazzam and Yoo, 2017 ; Uy et al, 2017 ). In these studies, nerve stimulation was able to inhibit or reduce the frequency of voiding, or to decrease the rate of micturition-like contractions produced under isovolumetric conditions by producing an increase in bladder capacity.…”

Section: Introductionmentioning

confidence: 99%

Suppression of Urinary Voiding by Conditional High Frequency Stimulation of the Pelvic Nerve in Conscious Rats

et al. 2018

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Female Wistar rats were instrumented to record bladder pressure and to stimulate the left pelvic nerve. Repeated voids were induced by continuous infusion of saline into the bladder (11.2 ml/h) via a T-piece in the line to the bladder catheter. In each animal tested (n = 6) high frequency pelvic nerve stimulation (1–3 kHz, 1–2 mA sinusoidal waveform for 60 s) applied within 2 s of the onset of a sharp rise in bladder pressure signaling an imminent void was able to inhibit micturition. Voiding was modulated in three ways: (1) Suppression of voiding (four rats, n = 13 trials). No fluid output or a very small volume of fluid expelled (<15% of the volume expected based on the mean of the previous 2 or 3 voids). Voiding suppressed for the entirety of the stimulation period (60 s) and resumed within 37 s of stopping stimulation. (2) Void deferred (four rats, n = 6 trials). The imminent void was suppressed (no fluid expelled) but a void occurred later in the stimulation period (12–44 s, mean 24.5 ± 5.2 s after the onset of the stimulation). (3) Reduction in voided volume (five rats, n = 20 trials). Voiding took place but the volume of fluid voided was 15–80% (range 21.8–77.8%, mean 45.3 ± 3.6%) of the volume expected from the mean of the preceding two or three voids. Spontaneous voiding resumed within 5 min of stopping stimulation. Stimulation during the filling phase in between voids had no effect. The experiments demonstrate that conditional high frequency stimulation of the pelvic nerve started at the onset of an imminent void can inhibit voiding. The effect was rapidly reversible and was not accompanied by any adverse behavioral side effects.

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Section: Introductionmentioning

confidence: 99%

Suppression of Urinary Voiding by Conditional High Frequency Stimulation of the Pelvic Nerve in Conscious Rats

et al. 2018

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“…Relevant animal studies have shown that RF treatment reduces bladder nerve density without evidence of lasting epithelial injury ( 24 ). RF electrical stimulation of pelvic nerves has a long-lasting inhibitory effect on the 0.5% acetic acid-induced detrusor overactivity rat model without causing significant nerve injury ( 25 ). There is one study that reported long-term improvement in pain and symptoms associated with interstitial cystitis in patients after RF treatment of the superior hypogastric plexus ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

A Multi-Center, Randomized, Blind, Controlled Clinical Trial of the Safety and Efficacy of Micro Radio Frequency Therapy System for the Treatment of Overactive Bladder

Zhang

Wang

et al. 2022

Front. Med.

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PurposeThe purpose of this study was to evaluate the efficacy and safety of low power micro radiofrequency (RF) therapy (μRFthera®) through urethra in the treatment of overactive bladders (OAB) through a prospective, single-blind, placebo-controlled, multi-center clinical protocol.Materials and MethodsOne hundred and fourteen patients with refractory OAB were randomized at 2:1 ratio, treatment to control undergoing same procedures except only the micro-RF treatment group at turned “on” setting in energy. Bladder diaries recorded during the screening period (3 days before enrollment) and during follow-up period on week 1, 3, and 7, respectively. The patients in control could choose receiving an energized treatment during extension stage.ResultsThe treatment efficacy was 76.1%. There was 49.80% rate improvement compared to control (95%CL 32.48%, 67.13%). The crude rate ration (RR) was 2.89, 95% CI (1.67–5.01) with p < 0.001 in uni-variate analysis, while the RR became 2.94, 95% CI (1.67–5.16) with p < 0.001 after adjusted potential confounding factors in multi-variate analysis. Statistically significant improvements have been demonstrated in the frequency of urination, urgency, nocturia, and quality of life (QoL) scores.ConclusionsMicro RF therapy is safe and effective for the treatment of OAB. The main treatment-related complications were catheterization related complications.Clinical Trial RegistrationZhejiang Device Registration Certificate No. 202090909, www.chictr.org.cn, Clinical Trial Accession Number: ChiCTR2100050096.

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“…At even higher frequencies, pulsed radiofrequency stimulation has also been shown to have the potential for modulating voiding. A 5‐minute period of short (80 ms) pulses at 500 kHz delivered to the pelvic nerve at 2 Hz was able to reverse the decrease in bladder capacity and reduce the frequency of bladder contraction in a rat model of cystitis . The effects of the 5‐minute period of stimulation lasted for at least 3.5 hours and appeared to be selective for pelvic nerve afferents (equivalent stimulation of the pudendal nerve had no effect) and importantly, did not induce nerve damage.…”

Section: Can Recent Advances In Understanding the Mechanism Of Action...mentioning

confidence: 94%

Sacral nerve stimulation for refractory OAB and idiopathic urinary retention: Can phenotyping improve the outcome for patients: ICI‐RS 2019?

Malde

Marcelissen

Vrijens

et al. 2020

Neurourology and Urodynamics

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Aims Sacral nerve stimulation (SNS) is widely used to treat refractory idiopathic overactive bladder (OAB) and idiopathic urinary retention. However, clinical outcomes are variable and understanding predictive factors for success or side‐effects would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence‐Research Society meeting 2019, a Think Tank was convened to discuss how advances in the basic science study of SNS may be translatable into clinical practice to improve outcomes of patients undergoing SNS treatment. Methods We conducted a literature review and expert consensus meeting focusing on current methods of phenotyping patients and specifically, how advances in basic science research of the mechanism of action of SNS can be translated into clinical practice to improve patient selection for therapy. Results The terms “Idiopathic OAB” and “idiopathic urinary retention” encompass several underlying pathophysiological phenotypes. Commonly, phenotyping is based on clinical and urodynamic factors. Animal studies have demonstrated that high‐frequency stimulation can produce rapid onset, reversible conduction block in peripheral nerves. Altering stimulation parameters may potentially enable personalization of therapy depending upon the clinical indication in the future. Similarly, advances in conditional and closed‐loop stimulation may offer greater efficacy for certain patients. Phenotyping based on psychological comorbidity requires further study to potentially optimize patient selection for therapy. Conclusions Idiopathic OAB and idiopathic urinary retention are heterogenous conditions with multiple potential underlying phenotypes. Tailoring stimulation parameters to the needs of each individual according to phenotype could optimize outcomes. Assessing psychological comorbidity may improve patient selection. Areas for further research are proposed.

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Effects of pulsed-radiofrequency neuromodulation on the rat with overactive bladder

Abstract: PRF electrical stimulation of pelvic nerves exerted a long-lasting effect of suppressing AA-induced detrusor overactivity. This modality can be used as an alternative approach for improving bladder continence in patients with overactive bladder syndrome.

Cited by 8 publications

References 30 publications

Suppression of Urinary Voiding by Conditional High Frequency Stimulation of the Pelvic Nerve in Conscious Rats

Suppression of Urinary Voiding by Conditional High Frequency Stimulation of the Pelvic Nerve in Conscious Rats

A Multi-Center, Randomized, Blind, Controlled Clinical Trial of the Safety and Efficacy of Micro Radio Frequency Therapy System for the Treatment of Overactive Bladder

Sacral nerve stimulation for refractory OAB and idiopathic urinary retention: Can phenotyping improve the outcome for patients: ICI‐RS 2019?

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